Endoscopic Closure of a Spontaneous Esophageal Perforation Using an Over-the-Scope Clip (OTSC®): A Conservative Approach to Boerhaave Syndrome

Boerhaave syndrome (BS), a rare and potentially fatal condition characterized by the spontaneous transmural rupture of the esophagus, often poses an initial diagnostic challenge due to its nonspecific clinical manifestations. Contrast-enhanced computed tomography (CT) is the preferred imaging modality for diagnosis. We present the case of a 63-year-old patient with multiple comorbidities who developed acute retrosternal chest pain following an episode of vomiting. Radiological imaging demonstrated a distal esophageal perforation, leading to the implementation of a conservative treatment approach involving ventilatory support, empirical antibiotic therapy, and thoracic drainage. Upper endoscopic examination identified the perforation, which was effectively closed with an Over-the-Scope Clip (OTSC^®; Ovesco Endoscopy AG, Tübingen, Germany). The patient experienced a positive clinical course, with resolution of the pneumothorax and subsequent transfer to a rehabilitation center. This case highlights the necessity of individualized therapeutic strategies in the management of BS and demonstrates the potential of minimally invasive endoscopic techniques, such as OTSC^®, as an effective option in stable and appropriately assessed patients.